Mastalgia and Galactorrhoea Flashcards
What is Galactorrhoea ?
Copious, bilateral, multi-ductal, milky discharge not associated with lactation or pregnancy
What hormone is responsible for lactation?
Prolactin
What hormone can inhibit the action of prolactin?
Dopamine
Most common cause of Galactorrhoea?
Hyperprolactinaemia
Causes of hyperprolactinaemia?
Pituitary adenoma
Medication
Idiopathic
Hypothyroidism
Renal and liver failure
How does hypothyroidism link to hyperprolactinaemia?
TRH stimulates the release of prolactin
Hypothyroidism = increased TRH
What is it key to exclude in a 27 year old patient presenting with Galactorrhoea?
Pregnancy
Exclude pregnancy in all patients of repprodyctive age
What does it suggest if serum prolactin levels are >1000mU/L?
Prolactinoma
What treatment would a patient with a prolactinoma get started on before surgery to remove the tumour?
Dopamine agonist therapy
Dopamine inhibits the effects of prolactin
What is mastalgia?
Breast pain
How likely is it that a patient presenting with mastalgia has breast cancer?
Low
Most common cause of mastalgia?
Cyclical pain - pain associated with the menstrual cycle
A patient comes in presenting with breast pain and no other relevant features. Does she require imaging?
No - breast pain in absence of any other relevant features is not an indication for imaging
